Relationship Between Quantitative Assessment Of Risk Factors Of Coronary Heart Disease And Severity Of Coronary Lesion

Objective:1,To investigate the relationship between common risk factors of coronary heart disease(CHD) and characteristics of injured coronary artery, and the relationship between the clustering of risk factors of CHD and coronary artery lesion.2,To study quantitative assessment of risk factors of CHD in evaluating severity and predicting occurrence rate of CHD patients,further for prevention and treatment of CHD.Methods:1,We studied 769 cases, who were selected to receive coronary angiograohy(CAG). Patients'preprandial blood was examined by routine assay.To compare the impact of risk factors of CHD on the result of CAG (positive rate), severity and extent of the coronary artery atherosclerosis(CAAS).Subsequently,the relationship between each risk factor and the coronary artery obstructive score(CAOS) was analyzed through correlation analysis. Logistic regression was applied for the analysis of risk factors of CHD.2,Risk factors of CHD of the above 769 cases were sumed up. To compare the impact of individual CHD risk factors aggregation on the positive rate of CAG, severity and extent of the CAAS, and the relationship between individual CHD risk factor aggregation and the CAOS, severity and extent of the CAAS through correlation analysis respectively.3,282 cases,who were selected from the above 769 cases,according to some specific stardand, were scored with Framingham,PROCAM and Chinese risk scores respectively.The relationship between the three risk scores and severity ,extent of the CAAS and the CAOS was compared through correlation analysis, Subsequently ,the difference of the three risk scores in predicting the occurrence rate of CHD were analyzed.Results:1. Each risk factor of CHD and coronary artery lesion1.1 Growing old and coronary artery lesionThe positive rate of CAG,extent and degree of CAAS increased significantly with age increased. In CHD group, age of patients with double-vessel disease(DVD) and triple-vessel disease(TVD) were higher than that of patients with single-vessel disease(SVD),while the level of age in occlusion disease was larger than that in moderate stenosis group.1.2 Gender and coronary artery lesion The positive rate of CAG in male was significantly higher than that in female, especially in<60 years. There was no significant difference in the proportion of different pathological extent in gender(p>0.05). The proportion of severe, occlussion lesion group in male were higher than that in female.1.3. Blood pressure and coronary artery lesion The positive rate of CAG with hypertension was higher than that with Non- hypertension . Compared with that in Non-CHD group ,the level of systolic blood pressure(SBP),pulse pressure(PP) in CHD group were significantly larger. There was significant difference in SBP,PP among different severity and extent of CAAS. The level of SBP and PP in TVD,severe and occlussion lesion patients were larger than that in SVD and moderate lesion patients. No significantly difference was found in the level of diastolic blood pressure(DBP) between either group. With the stage and duration of hypertension increased,the positive rate of CAG, extent and severity of the CAAS significantly increased.1.4. Blood lipid and coronary artery lesionThere was no significant difference in the positive rate of CAG between hyperlipemia and Non-hyperlipemia.In CHD patients, no significant difference was found in different extent and severity of CAAS between hyperlipemia and Non- hyperlipemia. Compared with that in Non-CHD group,the level of Low density lipoprotein cholesterol(LDL-C) in CHD group was higher,whereas the level of high density lipoprotein cholesterol(HDL-C) in CHD group was lower.Total cholesterol (TC),LDL-C of patients with DVD and TVD were higher than that of patients with SVD,whereas HDL-C of patients with DVD and TVD were lower. With the stenosis of CAAS increased,the concentration of TG,LDL-C increased gradually,while the concentration of HDL-C decreased.The concentration of TC increased gradually with stenosis increased,but had no significant difference.1.5 Obesity and coronary artery lesionNo significant difference was found between overweighters and Non- over weighters.In CHD patients,there was no significant difference in different extent and severity of CAAS between overweighters and Non-overweighters.Nor did the level of body mass index(BMI).1.6 Smoking and coronary artery lesionThe positive rate of CAG was higher in the smoker. Compared with Non- smoking patients with CHD,the proportion of TVD and occlusion lesion in the smoker were higher. There was significant difference in the number of cigarette consumed among different extent of CAAS,but the duration of cigarette consumed had not.The duration and number of cigarette consumed increased gradually with stenosis incresed, but had no significant difference.1.7 Diabetes and coronary artery lesionThe positive rate of CAG in Diabetes mellitus(DM) patients was significant- ly higher than that in Non-DM group,and fasting plasma glucose(FPG) of CHD patients was larger than that of Non-CHD patients. In CHD patients,the proportion of DM patients with occllusion, multiple vessles lesion were higher;and the level of FPG in multiple vessles,severe and occllusion lesion group were larger. 1.8 Serum Fibrinogen(Fg) and coronary artery lesionThe level of Fg in CHD group was significantly higher than that in Non-CHD group.In CHD patients, Fg of patients with TVD and occllusion lesion were larger.1.9. Serum creatinine(Cr) and coronary artery lesionThe value of Cr in CHD group was higher than that in Non-CHD group. Sign- ificant difference was found in the value of Cr among different severity of CAAS, but there was no significant difference among different extent of CAAS.The level of Cr in severe and occllusion lesion group were larger than that in moderate lesion group.1.10. Serum uric acid(UA) and coronary artery lesionThe concentration of UA in CHD group was higher than that in Non–CHD group. There were significant difference in the concentration of UA among diferent extent and severity of CAAS. The concentration of UA in TVD and occllusion lesion patients were larger.1.11. Heart rate(HR) and coronary artery lesionThe level of HR had no singificant difference between CHD group and Non -CHD group,but there existed significant difference in the level of HR among differrent severity of CAAS,and the level of HR in occllusion lesion was the highest.1.12 Leukocytosis and coronary artery lesionThe level of white blood cell(WBC) in CHD group was higher than in Non-CHD group. There was significant difference in the level of WBC among the different severity of CAAS,and the level of WBC in occllusion lesion was the highest。1.13 Red blood cell and coronary artery lesionThere was no significant difference in the level of RBC among different severity and extent of the CAAS.1.14. Correlation analysis between each risk factor of CHD and CAOS and logistic regression analysis on risk factors of CHD.Significantly positive correlation was presented between CAOS and DM, hypertension,smoking, age, stage and duration of hypertension, SBP,PP, number and duration of cigarette consumed, Leukocytosis, Fg, UA, Cr, FPG, TC, LDL-C,respectively,whereas a negative correlation between CAOS and female, HDL-C.The correlation between age and CAOS was the largest(r=0.330,p=0.000).It indicated by logistic regression analysis that the independent protecting factors of CHD were female,HDL-C,and the independent risk factors of CHD were age, DM, Fg, UA,LDL-C.2. Clustering of risk factors of CHD and coronary artery lesion Significant difference was found in the proportion of gender in the number of risk factors clustering in individuals.The proportion of participants have more than two risk factors in male was higher than that in female.With the number of risk factors clustering in individuals,the positive rate of CAG, extent and severity of CAAS gradually increased. Significantly positive correlation was presented between the number of risk factors clustering in individuals and CAOS, extent and severity of CAAS respect- ively.3. Quantitative assessment to risk factors of CHD and coronary artery lesionThree risk scores such as Famingham risk scores,PROCAM risk scores and chinese risk scores,significantly correlated with CAOS,extent and severity of CAAS respectively. Among them, PROCAM risk scores was the highest, while Framingham risk scores was the smallest.Risk scores increased with the severity of coronary artery pathological change advancing.The areas under of resident operation character(ROC)of Famingham risk scores,PROCAM risk scores and chinese risk scores,for predicting the incidence of CHD,was 0.585,0.694,0.610 respectively.The areas under of ROC of Famingham risk scores was the least, whereas that of PROCAM risk scores was the largest.Conclusions:1. The independent protecting factors for CHD were Female,HDL-C and the independent risk factors were age, DM, Fg, UA, LDL-C.significantly positive correlation was presented between CAOS and hypertension, smoking,DM, age,the stage of hypertension, the duration of hypertension, SBP,PP,smoking course,smoking,Leukocytosis , Fg ,UA ,Cr ,FPG ,TC ,LDL-C and a negative correlation between CAOS and female, HDL-C.2. The clustering of risk factors of CHD was associated with positive rate of CAG, the extent and severity of CAAS.3.Three risk scores such as Famingham risk scores,PROCAM risk scores and chinese risk scores,could be used to evaluate the severity of CAAS and predict incidence of CHD.PROCAM risk scores was the superiest.